Are Uric Acid and Uric Acid Creatinine Ratio Predictors for Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Yıl 2022, , 142 - 149, 31.08.2022

Hülya Abalı , Seda Tural Önür , Fatma Tokgöz Akyıl , Dilara Demir Sinem Nedime Sökücü Neslihan Boyracı

https://doi.org/10.29058/mjwbs.1027675

Öz

Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) klinik seyrinde, kötü prognoza neden olan, ek
tedavi gerektiren, solunum semptomlarında (dispne, öksürük, balgam) kötüleşme olarak tanımlanan
alevlenmeler gözlenebilir. Maliyet-etkin mortalite öngörücüleri, KOAH’ın tedavi yönetimi için değerlidir.Akut KOAH alevlenmeleri olan serum ürik asit (ÜA) ve serum ürik asitin kreatinine oranının (ÜKO) mortalite ve hipoksemi için belirleyici olup
olmadığını araştırmayı amaçladık.
Gereç ve Yöntemler: Bu gözlemsel kesitsel çalışmada, Ocak 2014 ile Aralık 2018 arasında bir referans göğüs hastanesinde yatan 105
KOAH alevlenmesindeki hasta retrospektif olarak değerlendirildi. ÜA ve ÜKO ile uzun vadeli mortalite, hipoksemi, komorbidite, FEV1 değeri,
KOAH’ın tanı, tedavi ve önlenmesi için küresel strateji (GOLD) evreleri arasındaki ilişkiler analiz edildi.
Bulgular: KOAH alevlenmesindeki toplam 105 hastayı (97’si erkek, ortalama yaş 65±9 yıl) içeren bu çalışmada hiperürisemi ile mortalite
arasında anlamlı bir korelasyon bulunurken (sırasıyla, p=0.027; p=0.016), ÜKO ile mortalite arasında korelasyon bulunmadı (sırasıyla,
p=0.051, p=0.053). Düşük ÜA seviyesi hipoksemi ile anlamlı olarak ilişkiliydi (p=0.022), ancak ÜKO ile hipoksemi arasında bir ilişki gözlenmedi
(p=0.094).
Sonuç: KOAH alevlenmesindeki hastaların uzun vadeli mortalitesini öngörmede serum ÜA’nin ÜKO’na göre daha değerli olduğu
görülmektedir. Sık klinik takip ve yoğun tedavi yönetimi gerektiren yüksek riskli KOAH hastalarının tanımlanması için serum ÜA’in uzun
vadeli mortalitenin biyobelirteci olarak kullanılabileceğini öneriyoruz.

Anahtar Kelimeler

Serum uric acid, serum uric acid creatinine ratio, predictor, mortality, hypoxemia, acute exacerbations of COPD

Kronik Obstrüktif Akciğer Hastalığının Akut Alevlenmesinde Ürik Asit ve Ürik Asitin Kreatinine Oranı Mortalitenin Öngörücüleri midir?

Öz

Aim: In the clinical course of Chronic Obstructive Pulmonary Disease (COPD), exacerbations that
are defined as worsening of respiratory symptoms (dyspnoea, cough, sputum production) may occur,
which causes poor prognosis and require additional treatments. Cost-effective mortality predictors are
valuable for the treatment management of COPD. We aimed to investigate whether serum uric acid
(UA) and serum uric acid to creatinine ratio (UCR) are predictors of mortality and hypoxemia in patients
with acute exacerbations of COPD (AECOPD).
Material and Methods: 105 patients with AECOPD who were hospitalized in a reference chest hospital
between January 2014 and December 2018 were evaluated retrospectively in this cross-sectional study.
The associations between UA and UCR and long-term mortality, hypoxemia, comorbidity, FEV1 value,
and Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary
Disease (GOLD) stage were analyzed.
Results: In the present study including 105 patients with AECOPD (97 males, mean age of 65±9 years),
a significant correlation was found between hyperuricemia and mortality (95% CI:1.15-10.72, p=0.027;
95% CI:1.16-4.12, p=0.016, respectively), while no correlation was found between UCR and mortality
(p=0.051, p=0.053, respectively). Low UA level was associated with hypoxemia significantly (p=0.022),
but no association was observed between UCR and hypoxemia (p=0.094).
Conclusion: It appears that UA is more important for predicting long-term mortality in patients with
AECOPD than UCR. We suggest that UA can be used as a biomarker of long-term mortality for the
identification of high-risk COPD patients that require frequent clinical follow-up and intense treatment
management.

Anahtar Kelimeler

Serum ürik asit, serum ürik asit kreatinin oranı, prediktör, mortalite, hipoksemi, KOAH akut alevlenme

Kaynakça

• Referans1 Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available from: http://www.goldcopd.org/Guidelines/guidelines-resources.html (2021, accessed 1 July 2014).
• Referans2 Seemungal TA, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157(5 Pt 1): 1418-1422.
• Referans3 Nicks ME, O’Brien MM, Bowler RP. Plasma antioxidants are associated with impaired lung function and COPD exacerbations in smokers. COPD 2011; 8(4): 264-269.
• Referans4 Parker CM, Voduc N, Aaron SD, et al. Physiological changes during symptom recovery from moderate exacerbations of COPD. Eur Respir J 2005; 26(3): 420-428.
• Referans5 Barbara JA, Roca J, Ferrer A, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J 1997; 10(6): 1285-1291.
• Referans6 Mentzer RMJr, Rubio R, Berne RM. Release of adenosine by hypoxic canine lung tissue and its possible role in pulmonary circulation. Am J Physiol 1975; 229(6): 1625-1631.
• Referans7 So A, Thorens B. Uric acid transport and disease. J Clin Invest 2010; 120(6): 1791-1799.
• Referans8 Johnson RJ, Kang DH, Feig D, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003; 41(6): 1183-1190.
• Referans9 Garcia-Pachon E, Padilla-Navas I, Shum C. Serum uric acid to creatinine ratio in patients with chronic obstructive pulmonary disease. Lung 2007; 185(1): 21-24.
• Referans10 Kahnert K, Alter P, Welte T, et al. Uric acid, lung function, physical capacity and exacerbation frequency in patients with COPD: a multi-dimensional approach. Respir Res 2018; 19(1): 110.
• Referans11 Acıcan T. Arterial Blood Gases. Yoğun Bakım Dergisi 2003; 3: 160-175.
• Referans12 Ryynanen OP, Soini EJ, Lindqvist A, et al. Bayesian predictors of very poor health related quality of life and mortality in patients with COPD. BMC Med Inform Decis Mak 2013; 13: 34.
• Referans13 Suissa S, Dell’Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67(11): 957–963.
• Referans14 Bartziokas K, Papaioannou AI, Loukides S, et al. Serum uric acid as a predictor of mortality and future exacerbations of COPD. Eur Respir J 2014; 43(1): 43-53.
• Referans15 Zhang X, Liu L, Liang R, Jin S. Hyperuricemia is a biomarker of early mortality in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10: 2519-2523.
• Referans16 Ogan N, Günay E, Baha A, et al. The Effect of Serum Electrolyte Disturbances and Uric Acid Level on the Mortality of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Turk Thorac J 2020; 21(5): 322-328.
• Referans17 Hwang JJ, Oh YM, Rhee CK, et al; KOLD Group. Hyperuricemia Is Not Predictive of Long-Term Outcome in Patients with Stable Chronic Obstructive Pulmonary Disease. J Korean Med Sci 2020; 35(8): e58.
• Referans18 Sato N, Kurashima K, Ubukata M, et al. Prognostic significance of serum uric acid in patients with chronic obstructive pulmonary disease receiving home oxygen therapy. Nihon Kokyuki Gakkai Zasshi 2003; 41(2): 74-80. Referans19 Rumora L, Hlapčić I, Popović-Grle S, et al. Uric acid and uric acid to creatinine ratio in the assessment of chronic obstructive pulmonary disease: Potential biomarkers in multicomponent models comprising IL-1beta. PLoS One 2020; 15(6): e0234363.
• Referans20 Kadowaki T, Hamada H, Yokoyoma A, et al. Significance of serum uric acid in patients with chronic respiratory failure treated with non-invasive positive pressure ventilation. İntern Med 2007; 46(11): 691-697.
• Referans21 Maiulo J, Oppedisano F, Gratteri S, et al. Regulation of uric acid metabolism and excretion. Int J Cardiol 2016; 213: 8-14.
• Referans22 Wang Q, Wang C, Xue J, et al. [Characteristics of serum uric acid distribution in occupation, age, gender groups and its influencing factors in physical examination subjects in Nanjing from 2012 to 2016]. Zhonghua Nei Ke Za Zhi 2021; 60(1): 29-34.
• Referans23 Klongthalay S, Suriyaprom K. Increased Uric Acid and Life Style Factors Associated with Metabolic Syndrome in Thais. Ethiop J Health Sci 2020; 30(2): 199-208.
• Referans24 Braghiroli A, Sacco C, Erbetta M, et al. Overnight urinary acid/creatinine ratio for detection of sleep hypoxemia: validation study in chronic obstructive pulmonary disease and obstructive sleep apnea before and after treatment with nasal continuous positive airway pressure. Am Rev Respir Dis 1993; 148(1): 173-178.
• Referans25 Saito H, Nishimura M, Shibuya E, et al. Tissue hypoxia in sleep apnea syndrome assessed by uric acid and adenosine. Chest 2002; 122(5): 1686-1694.
• Referans26 Durmus Kocak N, Sasak G, Aka Akturk U, et al. Serum Uric Acid Levels and Uric Acid/Creatinine Ratios in Stable Chronic Obstructive Pulmonary Disease (COPD) Patients: Are These Parameters Efficient Predictors of Patients at Risk for Exacerbation and/or Severity of Disease? Med Sci Monit 2016; 22: 4169-4176.
• Referans27 Aida Y, Shibata Y, Osaka D, et al. The relationship between serum uric acid and spirometric values in participants in a health check: the Takahata study. Int J Med Sci 2011; 8(6): 470-478.
• Referans28 Moberg M, Vestbo J, Martinez G, et al. Prognostic value of C-reactive protein, leucocytes and vitamin d in severe chronic obstructive pulmonary disease. Scientific World Journal 2014; 2014:140736.
• Referans29 Stolz D, Christ-Crain M, Morgenthaler NG, et al. Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007; 131(4): 1058-1067.
• Referans30 Man SF, Connett JE, Anthonisen NR, et al. C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease. Thorax 2006; 61(10): 849-853.